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B: Some dogs get socket prostheses, which just slip on over their stumps. What’s the advantage of an osseointegrated prosthesis?DML: Sometimes, we can’t use socket prostheses. In some specific locations they are not an option. They often are less energy efficient than the transdermal implant. They move out of alignment by an inch and suddenly, they don’t fit anymore. They become too loose or too tight or you have a lot of skin abrasions. If you’re going to go on a three- or four-mile walk, that would be very challenging. [With a socket prosthesis], there are very few dogs that can go on long walks. But with a transdermal implant, there is no limit to what you can do with your limb.

B: How do you think the procedure and approach will improve as time goes on?DML: There are a number of things in transdermal osseointegration that are less than perfect and are continually evolving. The process is very different now than in 2005, and most likely will be very different seven years from now. It’s a complicated idea—there are a number of features, and they all can be refined and optimized.

One challenge would be to design a foot that is very ergonomic: it’s easy to put on and [take] off, it’s very stable when it’s on, it’s light, it’s strong, it’s wear-resistant, it has good traction. We could imagine that these things could become more sophisticated over time.

I foresee that the process will become more standardized; I also think that it will become more rapid. And, of course, we will know more about it. Right now, we don’t know much—it’s just one case here, four cases there. As you can imagine, the field can be greatly improved. I think it’s going to play a big role in medicine. I spend a lot of time and energy for a few patients that have very big problems, thinking that it will trickle down to other patients in the future. I would like people to know that there are options if a dog is missing a foot or two—or maybe three or four.

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1. Penny - Penny’s leg was amputated after a bout with osteosarcoma and replaced with a foam-lined prosthetic made of thermoplastic, nylon and Velcro designed by Denis Marcellin-Little in conjunction with colleagues at Bio-Tech Prosthetics and Orthotics.

2. Zeus - As a five-week-old puppy, Zeus lost his paw in a dog attack. When Zeus reached his adult size, Marcellin-Little gave the dog an
osseointegrated implant with an attached prosthetic made of titanium. One end of the implant was anchored into bone, and the
other end protruded through the skin. Once the surgical wound healed, the tennis ball was removed.